Treatment of Advanced Ovarian Cancer When the Patient Is a Confirmed Poor Surgical Candidate or Optimal Cytoreduction Is Unlikely
In some patients with suspected or confirmed advanced-stage epithelial ovarian, fallopian tube, or primary peritoneal cancer, upfront surgery is not the initial step — either because the patient's overall condition makes surgery high-risk, or because achieving optimal cytoreduction is considered unlikely. A specific treatment pathway addresses this situation.
This protocol applies to patients with a confirmed poor surgical candidacy or a low likelihood of achieving optimal cytoreduction. In this setting, neoadjuvant chemotherapy with interval debulking surgery (IDS) is an established approach for patients with advanced-stage ovarian cancer who have a relatively poor performance status or disease extent that makes complete upfront resection unlikely.
- Confirmed poor surgical candidate or low likelihood of optimal cytoreduction
- NACT with interval debulking surgery (IDS) should be considered in patients with advanced-stage ovarian cancer who have a relatively poor performance status or have disease with low likelihood of optimal cytoreduction.
- Neoadjuvant therapy (category 1)
- Any of the primary IV regimens for stage II–IV high-grade serous carcinoma and respective LCOCs can be used as neoadjuvant therapy before surgery.
- If Bevacizumab is being used as part of a neoadjuvant regimen, Bevacizumab should be withheld from therapy for 4–6 weeks prior to surgery.
- Completion surgery after 3–4 cycles is preferred; however, surgery may be performed after 4–6 cycles based on the clinical judgment of the gynecologic oncologist.
- Neoadjuvant therapy: Drugs, radiation, or other forms of treatment given prior to cancer surgery intended to reduce tumor burden in preparation for surgery.